Some health care problems, part 1

I know a few people who have cataracts they need removed. One of them is actually getting it scheduled now; that is going to take 7 - 8 months.

One consequence is that a person whose ability to drive at night is being affected will not be getting it done before it starts getting dark before she leaves work.

Well, maybe if someone cancels.

This is not merely about the surgeon's availability; it also goes to how many rooms they have available and nurses too. With an aging population you are going to have more need for that particular surgery as well. For the available equipment and personnel that this particular health plan has, there is 7 - 8 months' worth of demand.

About a year ago I started a post called "The coming collapse of health care". Part of not finishing it was that I thought I was going to write about staffing issues and inefficiency, but then I got hung up on prescription drug costs and pharmaceutical company efforts to keep them high.

(Part of that was the manufacturer of Eliqis managing to get a three-year patent extension; so many seniors take that one.) 

Pricing was a problem. The Inflation Reduction Act was starting to help and was going to continue to do so, but of course the One Big Beautiful Bill Act is repealing a lot of that, because too much of the US population is hateful.

Regardless, the thing that was making my job worse -- and has continued to do so in my absence -- was that things were getting more confusing and difficult. While business was growing, staffing was not.

To be fair, a lot of that was caused by COVID. The workforce lost people, and people got sicker, and we have not really recovered from that. In many ways it got worse for the workers, but it was worse for the plan members too.

It wasn't just harder to get answers to your questions about what was covered; it was also harder to find available health care providers. Call centers weren't the only work force that lost people. Some were lost to death and disability, and there was a lot of burnout.

For the job I had, training was about two months, then about another month to get comfortable. That's at least for how I started. We kept getting different business lines added where we needed to learn new things. Then, because it is new, you don't have the same depth of knowledge across the team.

If you think three months is bad for getting new call center workers spun up, well, it takes a lot longer to get a nurse ready to go, or a doctor, or a pharmacist.

Part of that is the length of the training, but also, if tuition keeps going up and student loans keep becoming more predatory, you have fewer people who are even going to be eligible. 

I was talking with a graduate student in a demanding program a while back. She said the ones most likely to complete it were not the smartest or the hardest-working, but the ones with the most money behind them. It makes sense, but is that how you get the best medical force?

No. It's not.

This is a problem that you could consider to be a convergence of some different problems. That would be one thing, but there are many other problems rushing in as well.